<table border="0" width="100%" cellpadding="1" cellspacing="2">
	<tr>
		<td class="text_size12" valign="middle">Type</td>
		<td>
			<select name="cmbType" id="cmbType">
				<option value="#">Select Type</option>
				<option value="visit">Customer Visit</option>
				<option value="call">On Call</option>
			</select>
		</td>
	</tr>
	<tr>
		<td class="text_size12" valign="middle">Customer</td>
		<td>
			<select name="cmbCustomer" id="cmbCustomer">
				<option value="#">Select Customer</option>
			<?php
				foreach ($this->cust_arr as $cust_entry)
				{
			?>
				<option value="<?php echo $cust_entry['customer_id']; ?>"><?php echo $cust_entry['customer_name']; ?></option>
			<?php		
				}
			?>
			</select>
		</td>
	</tr>
	<tr>
		<td class="text_size12">Location</td>
		<td>
			<select name="cmbLocation" id="cmbLocation">
				<option value="#">Select Location</option>
				<?php 
					foreach ($this->city_arr as $city_entry)
					{
				?>
					<option value="<?php echo $city_entry['city_id']; ?>"><?php echo $city_entry['city_name']; ?></option>
				<?php		
					}
				?>					
			</select>
		</td>
	</tr>
	<tr>
		<td class="text_size12">Distance</td>
		<td>
			<input type="text" name="txtDistance" id="txtDistance" value="" class="inp-form" style="width: 200px;" /> KM(s)
		</td>
	</tr>
	<tr>
		<td class="text_size12">Rate(per KM)</td>
		<td>
			<input type="text" name="txtRate" id="txtRate" value="" class="inp-form" style="width: 200px;" />
		</td>
	</tr>
	<tr>
		<td colspan="2" align="right">
			<div style="padding: 10px 0 0 0; margin: 30px 0 0 0; float: left;" class="edit-icoset">
				<a id="addrate" onclick="addRates()" title="" href="javascript: void(0);"><img alt="" src="/images/icons/save-2.gif" />Add Rate</a>
			</div>
		</td>
	</tr>
</table>
